Short bowel syndrome is the clinical manifestation of a fundamental reduction in the functional intestinal absorptive surface area and malabsorption. The development of total parenteral nutrition has improved the natural course of this disease. Home parenteral nutrition-related complications continue to generate significant morbidity and mortality for these patients. Small-bowel transplantation is an alternative to home parenteral nutrition. There are significant risks of graft rejection and the potential complications oflong-term immunosuppression. Small-bowel transplantation is an option, but it should be reserved for patients no longer considered candidates for continued home parenteral nutrition.
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References
1.
Howard L., Heaphey L., Fleming CR, et al. Four years of North American registry home parenteral nutrition outcome data and their implications for patient management. JPEN1991; 15:384-93.
2.
Mughal M., Irving M.Home parenteral nutrition in the United Kingdom and Ireland. Lancet1986;2:383-7.
3.
Jeejeebhoy KN , Langer B., Tsallas G., et al. Total parenteral nutrition at home: studies in patients surviving 4 months to 5 years. Gastroenterology1976;71:943-53.
4.
Dudrick SJ, Latifi R., Fosnocht DEManagement of the short-bowel syndrome. Surg Clin North Am1991;71:625-43.
5.
Rombeau JL, Rolandelli R.Enteral and parenteral nutrition in patients with enteric fistulas and short bowel syndrome. Surg Clin North Am1987;67:551-71.
6.
Tilson MDPathophysiology and treatment of short bowel syndrome. Surg Clin North Am1980;60:1273-84.
7.
Weser E., Fletcher JT, Urban E.Short bowel syndrome. Gastroenterology1979 ;77:572-9.
Cooper A., Floyd TF, Ross AJ, et al. Morbidity and mortality of short-bowel syndrome acquired in infancy: an update. J Pediatr Surg1984;19:711-17.
10.
Quigley EM, Phillips SF, Cranley B., et al. Tone of canine ileocolonic junction: topography and response to phasic contractions. Am J Physiol1985;249:G30-7.
11.
Gorbach SL, Plaut AG, Nahas L., et al. Studies of intestine microflora : II Microorganisms ofthe small intestine and their relations to oral and fecal flora. Gastroenterology1967;53:856-67.
12.
Phillips SF , Giller J.The contribution of the colon to electrolyte and water conservation in man. J Lab Clin Med1973;81:733-46.
13.
Bond JH, Currier BE, Buchwals H., et al. Colonic conservation of malabsorbed carbohydrates. Gastroenterology1980;78:444-7.
14.
Haverstad T.Studies of short-chain fatty acid absorption in man. Scand J Gastroenterol1986;21:257-60.
15.
Ruppin H., Bar-meir S., Soergel KH, et al. Absorption of short-chain fatty acids by the colon. Gastroenterology1980;78:1500-7.
16.
Dowling RHSmall bowel adaptation and its regulation. Scand J Gastroenterol1982:17(suppl 74):53-74.
17.
Williamson RC, Chir M.Intestinal adaptation: structural, functional, and cytokinetic changes. N Engl J Med1978 ; 298:1393-402.
18.
Gouttebel MC , Saint Aubert B., Colette C., et al. Intestinal adaptation in patients with short bowel syndrome: measurement by calcium absorption. Dig Dis Sci1989;34:709-15.
19.
Caniano DA, Starr J., Ginn-Pease MEExtensive short-bowel syndrome in neonates: outcome in the 1980s. Surgery1989; 105:119-24.
20.
Meguid MM, Campos AC, Hammond WGNutritional support in surgical practice; part II. Am J Surg1990;159:427-43.
21.
Grosfeld JL , Rescorla FJ, West KWShort bowel syndrome in infancy and childhood: analysis of survival in 60 patients. Am J Surgery1986;151:41-6.
22.
Weber TR, Tracy T., Connors RHShort-bowel syndrome in children: quality of life in an era of improved survival . Arch Surg1991;126:841-6.
23.
De Potter S. , Goulet O., Lamor M., et al. 263 patient-years of home parenteral nutrition in children. Transplant Proc1992 ;24:1056-7.
24.
Starzl TE, Todo S., Tzakis A., et al. Multivisceral and intestinal transplantation. Transplant Proc1992;24:1217-23.
25.
Bowyer BA, Fleming CR, Ludwig J., et al. Does long-term home parenteral nutrition in adult patients cause chronic liver disease ? JPEN1985;9:11-7.
26.
Hodes JE, Grosfeld JL, Weber TR, et al. Hepatic failure in infants on total parenteral nutrition (TPN): clinical and histopathologic observations. J Pediatr Surg1982;18:463-8.
27.
Suita S., Ikeda K., Nagasaki A., et al. Follow-up studies of children treated with a long-term intravenous nutrition (IVN) during the neonatal period. J Pediatr Surg1982;17:37-43.
28.
Benjamin DR : Hepatobiliary dysfunction in infants and children associated with long-term total parenteral nutrition. A clinicopathologic study. Am Soc Clin Pathol1981;76:276-83.
29.
Meguid MM, Schimmel E., Johnson WC, et al. Reduced metabolic complications in total parenteral nutrition: pilot study using fat to replace one-third of glucose calories. JPEN1982;6:304-7.
30.
Buzby GP, Mullen JL, Stein TP, et al. Manipulation of TPN caloric substrate and fatty infiltration of the liver. J Surg Res1981;31:46-54.
31.
Grant JP, Cox CE, Kleinman LM, et al. Serum hepatic enzyme and bilirubin elevations during parenteral nutrition. Surg Gynecol Obstet1977;145:573-80.
32.
Preisig R., Rennert O.: Biliary transport and cholestatic effects of amino acids [Abstract] . Gastroenterology1977;73:1240.
33.
Capron JP, Herve MA, Gineston JL, et al. Metronidazole in prevention of cholestasis associated with total parenteral nutrition. Lancet1983;1:446-7.
34.
Fouin-Fortunet H., Quernec L., Erlinger S., et al. Hepatic alterations during total parenteral nutrition in patients with inflammatory bowel disease: a possible consequence of lithocholate toxicity. Gastroenterology1982;82:932-7.
35.
Penn D., Schmidt-Sommerfeld E., Pascur F.Decreased tissue carnitine concentrations in newborn infants receiving total parenteral nutrition. J Pediatr1981 ;98:976-8.
36.
Richardson TJ , Sgoutas D.Essential fatty acid deficiency in four adult patients during total parenteral nutrition. Am J Clin Nutr1975;28:258-63.
37.
Pallares R. , Sitges-Serra A., Fuentes J., et al. Cholestasis associated with total parenteral nutrition. Lancet1983;1:758-9.
Allardyce DB , Salvian AJ, Quenville NFCholestatic jaundice during total parenteral nutrition. Can J Surg1978;21:332-9.
40.
Ito Y., Shils MELiver dysfunction associated with long-term total parenteral nutrition in patients with massive bowel resection. JPEN1991;15:271-6.
41.
Stanko RT, Nathan G., Mendelow H., et al. Development of hepatic cholestasis and fibrosis in patients with massive loss of intestine supported by prolonged parenteral nutrition . Gastroenterology1987;92:197-202.
42.
Sax HC, Bower RH: Hepatic complications of total parenteral nutrition. JPEN1988;12:615-8.
43.
Langrehr JM , Reilly MJ, Banner B.; et al. Hepatic steatosis due to total parenteral nutrition: the influence of short-gut syndrome, refeeding, and small bowel transplantation. J Surg Research1991;50:335-43.
44.
Herfindal ET , Bernstein LR, Kudzia K., et al. Survey of home nutritional support patients. JPEN1989;13:255-61.
45.
OASIS home nutrition support patient registry, annual report 1987. Albany, NY: Oley Foundation ; and Silver Spring, MD: American Society for Parenteral and Enteral Nutrition, 1989.
46.
Sitzmann JV , Townsend TR, Siler MC, et al. Septic and technical complications of central venous catheterizations: a prospective study of 200 consecutive patients. Ann Surg1985;202:766-70.
47.
McCullough ML, Hsu N.Metabolic bone disease in home parenteral nutrition. J Am Diet Assoc1987 ;87:915-20.
48.
Von Allmen D. , Fischer JEMetabolic complications. In: Fischer JE, ed. Total parenteral nutrition , 2nd ed. Boston: Little Brown, 1991:47-55.
49.
Lennard-Jones JEIndications and need for long-term parenteral nutrition: implications for intestinal transplantation. Transplant Proc1990;22:2427-9.
50.
Hall RCW , Beresford TPPsychiatric factors in the management of long-term hyperalimentation patients . Psych Med1987; 5:211-7.
51.
Tarter RE, Erb S., Biller P., et al. The quality of life following liver transplantation: a preliminary report. Gastroenterol Clin North Am1988;17:207-17.
52.
Stenn PG, Lammens P., Houle L., et al. Psychiatric psychosocial and ethical aspects of small bowel transplantation. Transplant Proc1992;24:1251-2.
53.
Tzakis AG, Todo S., Reyes J., et al. Clinical intestinal transplantation : focus on complications . Transplant Proc1992;24:1238-40.
54.
Todo S., Tzakis A., Reyes J., et al. Clinical small bowel or small bowel plus liver transplantation under FK-506. Transplant Proc1991;23:3093-5.
55.
Margreiter R., Königsrainer A., Schmid T., et al. Successful multivisceral transplantation . Transplant Proc1992;24:1226-7.
56.
Goulet O., Révillon Y., Canioni D., et al. Two and one-half year follow-up after isolated cadaveric small bowel transplantation in an infant. Transplant Proc1992;24:1224-5.
57.
Grant D., Wall W., Mimeault R., et al. Successful small-bowel/liver transplantation. Lancet1990;335:181-4.
58.
Williams JW , Sankary HN, Foster PF, et al. Splanchnic transplantation : an approach to the infant dependent on parenteral nutrition who develops irreversible liver disease. JAMA1989;261:1458-62.
59.
McAlister V. , Wall W., Ghent C., et al. Successful small intestine transplantation . Transplant Proc1992;24:1236-7.
60.
Schroeder P. , Goulet O., Lear PASmall-bowel transplantation: European experience [Letter]. Lancet1990;336:110-1.
61.
Starzl TE, Rowe MI, Todo S., et al. Transplantation of multiple abdominal viscera. JAMA1989;261:1449-57.
62.
Abu-Elmagd, Fung JJ, Reyes J., et al. Management of intestinal transplantation in humans. Transplant Proc1992;24:1243-4.
63.
Rosemurgy AS , Schraut WHSmall-bowel allografts: sequence of histologic changes in acute and chronic rejection. Am J Surg1986;151:470-5.
64.
Cohn WB, Hardy MA, Quint J., et al. Absorptive function in canine jejunal autografts and allografts . Surgery1969; 129: 1163-72.
65.
Leapman SB, Deutsch AA, Grand RJ, et al. Transplantation of fetal intestine: survival and function in a subcutaneous location in adult animals. Ann Surg1974;179:109-14.
66.
Nordgren S. , Cohen Z., Mackenzie R., et al. Functional monitors of rejection in small- intestinal transplants. Am J Surg1984 ; 147:152-8.
67.
Billiar TR, Garberoglio C., Schraut WH: Maltose absorption as an indicator of small- intestinal allograft rejection . J Surg Res1984;37:75-82.
68.
Yagi M., Masutani H., Tomita K., et al. Changes in intestinal mucosal protective function after small bowel transplantation. Transplant Proc1992 ;24:1126-7.
69.
Schraut WHCurrent status of small-bowel transplantation. Gastroenterology1988;94:525-38.
70.
Hamamoto I. , Merhav H., Zhu Y., et al. Lipid peroxidation, brush border, and neutrophil enzyme activity after small bowel preservation : a comparison of preservation solutions. Transplant Proc1992;24:1095.
71.
Fabian MA, Bollinger RRRapid translocation of bacteria in small bowel transplantation. Transplant Proc1992;24:1103.
72.
Schweizer E. , Gassel A., Deltz E., et al. Morphologic and histologic alterations after small-bowel transplantation: a comparison of different perfusion solutions . Transplant Proc1992;24:1087.
73.
Scholten E. , Manek S., Pearson J., et al. Ischemia and long-term reperfusion injury in a one-stage orthotopic rat small bowel transplantation model: when and where to biopsy? Transplant Proc1992;24:1096-7.
74.
Liu H., Teraoka S., Nozawa M., et al. Successful lymphangiographic investigation of mesenteric lymphatic regeneration after orthotopic intestinal transplantation in rat. Transplant Proc1992;24:1113-4.
75.
Gundlach M. , Schroeder P., Schindler R., et al. Absorption of vitamin A after orthotopic small bowel transplantation: evidence for the development of graft adaptation to lipid metabolism. Transplant Proc1987;19:3965-7.
76.
Kitagawa H. , Ford EG, Sinatra F., et al. Fecal fat, cyclosporine, and alpha-1 antitrypsin for assessment of small bowel function following transplantation . J Pediatr Surg26:1091-6, 1991.
77.
Thompson JS , Rose SG, Spanta AD, et al. The long-term effect of jejunoileal autotransplantation on intestinal function. Surgery1992;111:62-8.
78.
Raju S., Fujiwara H., Grogan JP, et al. Long-term nutritional function of orthotopic small bowel autotransplants . J Surg Res1989;46:142-6.
79.
Johnson CP, Cowles VE, Bonham L., et al. Changes in motility, transit time, and absorption following surgical transection of the jejunum. Transplant Proc1992;24:1110-2.
80.
Hakim NS, Walters AM, Zinsmeister AR, et al. Net absorption of water, electrolytes, glucose, and folate from the in vivo, neurally isolated canine jejunum. Surgery1992;111:394-401.
81.
Watson AJM , Lear PA, Montgomery A., et al. Water, electrolyte, glucose, and glycine absorption in rat small-intestinal transplants. Gastroenterology1988;94:863-9.
82.
Quigley EMM , Thompson JS, Rose SG: The long-term function of canine jejunoileal autotransplants: insights into allograft physiology . Transplant Proc1992;24:1105-6.
